A new treatment for stomach cancer in which chemotherapy drugs are delivered in aerosol form directly to the site needing treatment rather than systemically is showing some promise in decreasing the well-known and debilitating side effects from traditional chemotherapy.

Pressurised Intraperitoneal Aerosol Chemotherapy (PIPAC) involves laparoscopy, whereby the anaesthetised patient has an incision made in the abdominal wall, following by injection of air to create a cavity into which the aerosolised drug is sprayed and left for 30 minutes to allow the aerosol to deposit, before the remainder is pumped out and the incisions sutured.

Because very little of the drug enters the bloodstream, many patients in the trial, which is currently taking place in 7 French hospitals, are not experiencing side effects such as loss of appetite, peripheral nerve and blood cell damage and hair loss. Another advantage is that traditional treatments through the bloodstream have to pass through the peritoneal wall membrane, which has few blood vessels, reducing the efficacy of normal chemotherapy. The treatment cost is also ‘reasonable’, at around 2000 Euros per treatment (plus 25,000 Euros for the injector). However, the need for an air cavity currently limits the treatment to digestive tract and gynaecological cancers, although the hope in the future is that bladder and lung cancers could be treated in a similar manner. Preliminary results for a multi-centre trial in France should be produced within the next five years.

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